A 56-year-old male patient underwent percutaneous biopsy of a nodule in the right lung apex (Figure 1A). The tip of a 19-gauge coaxial needle was positioned in the posterior chest wall (Figure 1B), and six samples of the lesion were ob-tained with a 20-gauge core needle. The pathological analysis revealed squamous cell carcinoma. Using an anterior approach, we performed right upper lobectomy with tumor-free margins. At 6 months of follow-up, a positron emission tomography-CT scan of the chest showed an 18F- fluorodeoxyglucose-avid soft tissue mass (Figure 1C) in the T3-4 inter-space, along the biopsy tract, as well as bone erosion of the right third rib posteriorly (Figure 1D), suggesting tumor seed-ing. A subsequent CT scan of the chest, obtained two months later, confirmed local disease progression. We then per-formed en bloc resection with disease-free pleural margins, and the pathological analysis confirmed that tumor seeding had occurred.
 



Tumor seeding along the biopsy route is exceedingly rare. Certain factors, such as the use of large-bore cutting needles, increase the risk of such tumor cell dissemination, that risk also being greater when the tumor is an adenocarcinoma.

RECOMMENDED READING

1. Kim JH, Kim YT, Lim HK, Kim YH, Sung SW. Management for chest wall implantation of non-small cell lung cancer after fine-needle aspiration biopsy; Eur J Cardiothorac Surg. 2003;23(5):828-32. http://dx.doi.org/10.1016/S1010-7940(03)00095-2